Dec 15, 2020
EMRA*Cast host Dr. Shreyans Sanghvi takes a deep dive on the history, current practice, and future direction of cardiac arrest management and advanced resuscitation medicine with research pioneers Dr. Lance Becker and Dr. Sam Parnia.
Overview
Each year hundreds of thousands of
Americans suffer from cardiac arrest out of the hospital. CPR has
been a core tenet in the rescue algorithm for patients in cardiac
arrest, but how do we transform this age-old treatment with today's
advances in technology, and to where do we turn when CPR alone is
ineffective?
Dr. Lance Becker, chair of Emergency Medicine at Northwell Health North Shore - LIJ, and Dr. Sam Parnia, director of Critical Care Research at NYU Langone Medical Center, discuss lessons they've learned along the way dedicating their lives to the research and treatment of patients in cardiac arrest.
Key Points
- CPR is the single most-effective measure in the resuscitation of patients in cardiac arrest.
- CPR when used in tandem with real-time biomarkers such as end tidal CO₂, arterial line pressure, and ultrasound can be utilized to monitor CPR efficacy in real time.
- A team-focused, multi-disciplinary video review of cardiac arrest management can help improve outcomes in patients and identify barriers to achieving adequate reperfusion.
- Upon achieving ROSC, provider efforts should be dedicated to minimizing the amount of reperfusion injury patients incur.
- Providers should resist the urge to correct acidosis (in the immediate post-ROSC phase) by increasing the ventilator respiratory rate, as decreased CO₂ levels can precipitate cerebral vasoconstriction and worsen brain ischemia.